Category Archives: Smoking Cessation

‘We give people their humanity back’: inside Croatia’s pioneering mental health centre

High walls still surround the oldest asylum in the Balkans, an 18th-century building pocked with the artillery scars of last century’s civil war, but the gates are no longer locked. Handles have been replaced on internal doors and bars removed from windows.

“The jail,” said Darko Kovaoic, a 53-year-old poet with schizophrenia who lives here, “has broken open.”

The institution in Osijek, eastern Croatia, is run by Ladislav Lamza, a former social worker who is taking on the government, the health minister, and his own staff to transform the lives of his “beneficiaries” – the patients of what was until recently an old-style asylum.

It was in May 2015 that Lamza ripped down the sign outside – replacing “Home for the Insane” with “Centre for People Like Us” and began moving people out.

“We express many things in that small sentence,” said Lamza. “Because what we have done for the past two centuries is the opposite. We’ve said: ‘You are not like us, you are ugly and mad and I’m not like you.’ This is where we exclude, stigmatise and restrain people for the rest of their lives.

“We have people in need and we provide inappropriate help and the result is catastrophic. I never knew anyone who was rehabilitated. We make equality between criminals and people with disabilities.”

Lamza’s transformation of the centre caused shock and upset: one member of staff pointed out that these were people who should have been “exterminated”.

In four years, 172 out of 200 people have been successfully moved into shared flats dotted around the small city, with carers from the centre visiting them as needed.

As his institution emptied, Lamza ditched the metal bed frames and stained mattresses. Although the paint still peels and the furniture is scratched and sagged, he has turned the bleak, soulless wards into rooms for day classes, a library and a bright cafe where former patients demonstrate how to make pancakes and brew tea for other ex-patients who come by daily to grow cabbages in the gardens or to chat with staff. Staff are no longer janitors, nurses, cooks or cleaners, but all re now “care assistants”. The transformation, says Butkovic Jadranka – formerly a hairdresser here, now running sewing classes and shopping and theatre trips – is amazing.

Slavica Hip left the home three years ago and now lives in Osijek with her boyfriend. ‘In the institution I would take more pills. Now my medication has been reduced. I feel better,’ she says.


Slavica Hip left the home three years ago and now lives in Osijek with her boyfriend. ‘In the institution I would take more pills. Now my medication has been reduced. I feel better,’ she says. Photograph: Photo: Robin Hammond/NOOR

“When we first heard of the director’s plans, I was fearful, everyone was fearful, we thought perhaps he had gone a little crazy. But now everything is completely different. Before it was like they were objects, slightly out of focus objects. Just numbers. Like on a conveyer belt. I never asked anyone’s name. Now they are my friends. People are not dangerous lunatics, they have become citizens, they have become neighbours.”

It is 10 years since Croatia signed the UN’s Convention on the Rights of Persons with Disabilities but Osijek is the only one of Croatia’s 24 mental health institutions, which house a total of 6,700 people, implementing its spirit. “We signed this with our fingers crossed behind our backs. The government still wants people locked up, locked away. People with disabilities, whether mental health or physical, have rights. There are four reasons why inclusion is better than exclusion,” said Lamza. “It’s better for a person, it’s better for the community, it’s legal, it’s cheaper.” He says the cost per person per month in an institution is $ 1,260 (£950). “In the community, even with the maximum 24-hour support, it is $ 1,020.

“The first day I let people go I didn’t sleep: will she hurt someone, will he cope? But there have been no problems. People have thanked us for giving them the best neighbours they have ever had!”

After 12 years in institutions, Branka Reljan, 55, has spent three years living in the community, in a shared flat with her partner Drazenko Tevlli. She speaks fluent German and English but has suffered mental health breakdowns since university and has let go of old ambitions. Now the couple take great delight in visiting cafes and shops. “We met in the institution but love is not allowed so we lived a secret for 11 years. I say I was in prison before. Now I love to make apple pies and buy spices and oils for cooking. It is wonderful for us to have our own keys, to buy fresh juice and to take a bus. We are satisfied with our neighbours. We are happy.”

Zoran Stih and Ruzica Vidakovic met at the institution in Osijek. They moved out in 2015 and are now married and living in an apartment in the town.


Zoran Stih and Ruzica Vidakovic met at the institution in Osijek. They moved out in 2015 and are now married and living in an apartment in the town. Photograph: Photo: Robin Hammond/NOOR

If other asylums in Croatia had any desire to follow Lamza’s care in the community model it would be more difficult. Most were built far from towns.

Rada Matos is the director of Ljeskovica home for mentally ill adults, deep in the Pozega forest, an hour’s drive from Osijek. Lamza describes it as “a warehouse for lost souls”. Matos says she does her best for the 284 people here but points out that Croatia is a poor country and mental health is both under-resourced and stigmatised. “We have no psychologists and no psychiatrists, no professional is interested in coming out here to work, yet perversely we are the main employer in the area for unskilled workers. It’s too far for relatives to visit and there is no community for people to live in even if I had the resources to try. There is a tiny village of uneducated people to whom this is the madhouse.”

There is a long waiting list to come here but few leave. “Maybe two a year,” she said. “We try to explain mental health is an illness, we invite in families, school groups. But what I’d really need to do is move this building somewhere else, somewhere where there is a community.”

Around the grounds and in the corridors, people stand or wander in shabby clothes too big or too small. Miryama Nikoli, 38, is new to Ljeskovica but has been institutionalised for 18 years. Eyes glazed by medication that hasn’t been changed in all that time, she talks to everyone about her daughter, taken away as a baby. “I was sick because of my nerves but now I suffer because of my baby,” she says. “I drink the medicine but I want to see her again.” Matos pulls out her file; her background is heart-breaking and abusive. One line mentions the child, who will now be 18. The file contains four A4 pages.

In Osijek the belief is that lives are better on the outside. Care assistant Vlatka Griner said the hardest task in moving people into the community was to make them use chairs: “At the asylum, they squat in the corridors, smoking. Squat, smoke, move a bit and squat again. What else did they have to do? In only slippers, just slippers because they never went out. When they are in the apartments the hard thing is to get people to sit in chairs. It can take a good two months.

“Then they go to the shops, buy their own food, buy their own clothes, run their own lives. Brush their hair. They’re unrecognisable.”


‘Love was not allowed in the institution. Now we are outside we have our own keys and take a bus. We are happy’

It is not a solution for everyone. Back in Osijek, Zdenko Kovac, 64, is a convicted murderer and, although he claims the scars on his head are from an axe wielded by his wife and he is not deemed dangerous enough for a secure hospital, he has failed to cope outside and is back in the institution where he wants to stay “until I die”.

“He is someone I worry about,” admits Lamza, “he wants to stay and ideally he will.” For others, it was never the right place. Luka Bobanovic, 36, caught a fever aged seven that left him brain-damaged. His mother handed him over to state care and he has been bounced around from institution to institution. “When he came to us he was very disturbed,” said Lamza. “Eight times Luka went through a door or window, either him chasing staff or them chasing him. The doctor told staff to tie him to his bed. I found him like that, tied to his bed, crying for his mamma. The staff shrugged and told me ‘we are scared of him’.”

Now he lives in a small bungalow with three other beneficiaries and round-the-clock care.“Our work doesn’t end when people live outside the institution,” said Lamza. “We are supporting them to live like every citizen of this town, to fall in love, dance, eat pancakes. I want to give people back a reason to live. That is what we have been taking from them, their humanity.

“I’m ashamed of how people lived before, but I’m happy,” Lamza said, “because they’re happy.”

Cross-party MPs request urgent non-partisan debate on future of NHS

Ninety MPs including several senior Tories have urged Theresa May to launch a cross-party convention on the future of the NHS and social care in England.

Sarah Wollaston, chair of the Commons health committee, organised a letter in conjunction with the Liberal Democrat former care minister Norman Lamb and Labour’s former shadow care minister Liz Kendall, that has been sent to the prime minister and the chancellor, Philip Hammond.

The MPs say the health system has been failing patients and they call on Hammond to ensure any moves to lift the public sector pay cap for NHS workers is not funded by raiding existing health budgets.

The signatories, one-third of whom are Conservative MPs, have said only a non-partisan debate can deliver a “sustainable settlement”. They say the failure of normal party politics to secure the future of the system means a non-partisan approach is the only way to ensure action is taken, particularly given that the government does not command a majority.

“The need for action is greater now than ever,” say the MPs, who include about 30 former ministers. “We understand that fixing this is immensely challenging and involves difficult choices.

“We all recognise, though, that patients and those needing care are too often failed by a system under considerable strain. We believe that together we owe a duty of care to the people of this country to confront the serious challenges to the NHS and the social care system.”

The Tory signatories include the former education secretary Nicky Morgan, the former international development secretary Andrew Mitchell, George Freeman, a former policy adviser to May, and the party grandee Sir Nicholas Soames.

The Labour MPs who have signed include Kendall, Chuka Umunna, Hilary Benn, Frank Field and Caroline Flint. Liberal Democrats signatories include the party leader, Sir Vince Cable, as well as Ed Davey and Tim Farron.

In a series of tweets Wollaston said:

Sarah Wollaston (@sarahwollaston)

. Govt also needs to focus on the long term, stop planning for health & social care in separate silos as this approach is setting us up for failure. Finance & workforce need urgent attention for the here & now but also for the long term & MPs from all Parties ready to engage

November 18, 2017

Sarah Wollaston (@sarahwollaston)

Current plans to kick social care into the long grass (again) & to separate planning for young and older adults creates even further fragmentation . Essential to think about whole system of NHS & Care

November 18, 2017

In the letter, MPs argue that only a cross-party NHS and social care convention where there can be a non-partisan debate can ensure a long-term settlement.

This was echoed by Wollaston in further comments in which she said: “The simple reality of a hung parliament means that all our constituents will be failed if long-term plans for NHS and [social] care funding do not command cross-party support.”

She added: “It’s better to take a joint approach to planning from the outset and actually deliver.”

Although MPs recognised that the challenge facing the government involved making difficult choices, they say “patients and those needing care are too often failed by a system under considerable strain”.

Lamb said: “Tribal politics has failed to provide a solution to the existential challenges facing the NHS and social care. We know that the current situation is unsustainable, and these pressures will only get worse as we contend with an ageing population and rising demand for care and treatment.

“This letter shows the strength of cross-party support for a new approach based on cooperation instead of political point-scoring. The fact that so many senior MPs and former cabinet ministers support this initiative is remarkable. Now the government must act on it.”

Kendall said: “Our population is ageing, more people need help and support and our care services desperately need more money to cope, yet any party that comes up with a significant proposal for funding social care risks their political opponents destroying them.

“We could carry on like this for yet another parliament, and yet another election, or we could face up to reality: we will only get lasting change if we secure a cross-party approach.”

According to NHS England chief executive, Simon Stevens, the fall per head in NHS funding means the health service will not be able to meet its routine waiting-time commitments.

Representatives from the Nuffield Trust, Health Foundation and King’s Fund said this year that austerity combined with increasing demand for services had created a “mounting toll on patient care”. They said there was growing evidence that access to some treatments was being rationed and that quality of care in some services was being diluted.

Solving the problem would mean a “steadily increasing share of national income would need to be spent on providing these services,” they said.

The UK spends 9.9% of GDP on the health budget – a considerably lower percentage than many other European nations.

Niall Dickson, chief executive of the NHS Confederation, which represents various organisations in the healthcare system, said promises to reform funding were being “kicked down the road”.

He said: “The government promised reform before the election, then said there would be a green paper before Christmas. Now it has been put off until summer next year – and even then we are not being promised firm commitments.”

A government spokesperson said: “We have announced a cross-government green paper on care and support for older people with input from a group of independent experts. We recognise that there is broad agreement across parliament that reform for social care is a priority and look forward to hearing a range of views.”

They said MPs would be consulted on social care before the green paper policy statement next year. The government had already provided an additional £2bn to social care over the next three years, the spokesperson said, adding that the government was committed to making the sector sustainable.

Losing a child to suicide is devastating. Schools can help prevent these tragedies

The tragedy of losing a child is unimaginable. Losing a child to suicide is worse. Those who have endured such horrors will know the grief is utterly excruciating. It’s no wonder that parents who have lost children in such a way become serious risks of suicide themselves.

My son Patrick was 25 when he took his own life, although I believe his suicidal thoughts began in childhood. It’s distressing to think that an average of four schoolchildren take their own lives every week in Great Britain and Northern Ireland. The majority are teenagers, but some are still in primary school – and because the official statistics don’t recognise suicides by children under 10, that number is likely to be even higher.


The 200 children lost to suicide each year could be dozens more. E​ven if it’s dozens less it’s still a national scandal

Coroners seem particularly reluctant to find suicide verdicts in the case of children, perhaps in their desire to spare families further pain. Such is the stigma that still exists around suicide. The requirement to meet the criminal standard of proof, “beyond reasonable doubt”, also makes it difficult for them to reach this conclusion. The charity Papyrus, which works to prevent young suicide and of which I am now a trustee, continues to press the Department of Justice for change. Only when a suicide verdict can be recorded on the “balance of probabilities” will the true scale be revealed.

As things currently stand, the 200 schoolchildren lost to suicide each year in the UK could be dozens more. Even if it was dozens less, it would still be a national scandal. Those of us in the club that no one wants to join are aware that life will never be the same again. Yet the grief is not confined to parents – the suicide of a child has a devastating effect on siblings, family, friends and entire school communities.

Schools are in a unique position to help prevent these tragedies. Children spend much of their waking hours at school, so teachers are in the right place to recognise that a child might be at risk. But without effective training or guidance, the opportunity for such interventions are lost. So while a recent YouGov survey commissioned by Papyrus found that more than 10% of teaching professionals said a student shares suicidal thoughts with them at least once a term, only half felt confident they could provide adequate support.

As part of its current campaign – Save the Class of 2018 – which aims to increase teacher awareness of suicide prevention, Papyrus has created a free guide (pdf) to give schools and colleges the information they need to support students who might be at risk of suicide.

It includes guidance on prevention, such as how to improve connectedness, developing a suicide prevention policy, and helpful and unhelpful language to use. There’s intervention advice, which covers what to do when you have a concern, what to look out for, and how to ask about suicide. It covers what to do after a pupil has taken their own life, how to inform and support other students, and how to communicate with the media.

The guide is very deliberately aimed at the whole school community, because it could be a teacher, secretary, dinner lady or support assistant who first identifies a vulnerable student. The challenge now is making all of our 20,000-plus UK schools aware of it.

Of course, this is not just a school issue, but a societal one. Suicide prevention is everyone’s business, but human nature tends to persuade us, until fate intervenes, that tragedies like suicide affect other people and not us.

Had I, as a headteacher, been told just how critical it was to have a suicide prevention plan in place, I’m pretty confident that I would have acted on it. Every school community we get on side could help to save even more young lives.

In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

Follow us on Twitter via @GuardianTeach, like us on Facebook, and join the Guardian Teacher Network the latest articles direct to your inbox

Looking for a teaching job? Or perhaps you need to recruit school staff? Take a look at Guardian Jobs, the education specialist.

Use carrot and stick to tackle obesity crisis | Letters

The UK is the “most obese nation in western Europe” (Report, 11 November), and there is widespread agreement that a range of measures is required to address this problem. One such measure, the government’s proposed sugar tax on soft drinks, should therefore be commended, especially since it introduces the concept of using price policies to promote healthier eating. However, the policy is likely to be more effective if the stick of the sugar tax is balanced by a carrot of subsidies on fruit and vegetables, increased consumption of which protects against numerous disorders – notably heart disease, stroke and bowel cancer – and is likely to limit the rise in obesity. As the WHO pointed out in its 2015 report Using Price Policies to Promote Healthier Diets, “Taxes on sugar-sweetened beverages and targeted subsidies on fruit and vegetables emerge as the policy options with the greatest potential to induce positive changes in [food] consumption”. However, as the WHO says, extra government intervention will likely be required to bring the price of fruit and veg down to a level everyone can afford and provide the maximum benefit to all. This will require more research on price policy strategies of how to spend the tax on sugar-containing drinks – something which was not the remit of the government’s adviser, Public Health England.
Henry Leese
Windermere, Cumbria

Your report says correctly that the government’s childhood obesity strategy was heavily criticised “for its reliance on voluntary action by the food and drink industry and lack of restrictions on the marketing and advertising of junk food”. It was also criticised for making no reference to breastfeeding, or to the current inadequate restrictions on marketing and advertising of breastmilk substitutes that contravene the WHO code. Obesity begins in infancy, and it is no accident that the breastfeeding rate in Britain is among the lowest in Europe.
J Peter Greaves
London

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

Use carrot and stick to tackle obesity crisis | Letters

The UK is the “most obese nation in western Europe” (Report, 11 November), and there is widespread agreement that a range of measures is required to address this problem. One such measure, the government’s proposed sugar tax on soft drinks, should therefore be commended, especially since it introduces the concept of using price policies to promote healthier eating. However, the policy is likely to be more effective if the stick of the sugar tax is balanced by a carrot of subsidies on fruit and vegetables, increased consumption of which protects against numerous disorders – notably heart disease, stroke and bowel cancer – and is likely to limit the rise in obesity. As the WHO pointed out in its 2015 report Using Price Policies to Promote Healthier Diets, “Taxes on sugar-sweetened beverages and targeted subsidies on fruit and vegetables emerge as the policy options with the greatest potential to induce positive changes in [food] consumption”. However, as the WHO says, extra government intervention will likely be required to bring the price of fruit and veg down to a level everyone can afford and provide the maximum benefit to all. This will require more research on price policy strategies of how to spend the tax on sugar-containing drinks – something which was not the remit of the government’s adviser, Public Health England.
Henry Leese
Windermere, Cumbria

Your report says correctly that the government’s childhood obesity strategy was heavily criticised “for its reliance on voluntary action by the food and drink industry and lack of restrictions on the marketing and advertising of junk food”. It was also criticised for making no reference to breastfeeding, or to the current inadequate restrictions on marketing and advertising of breastmilk substitutes that contravene the WHO code. Obesity begins in infancy, and it is no accident that the breastfeeding rate in Britain is among the lowest in Europe.
J Peter Greaves
London

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

NHS cash squeeze forces hospitals to postpone non-urgent operations

The NHS is under fire for forcing patients who need surgery to wait at least three months before they can have an operation in order to save money.

NHS clinical commissioning groups (CCGs) in Lincolnshire have provoked sustained criticism after deciding to introduce minimum waiting times for non-urgent surgery including cataract operations and joint replacements.

They have adopted the policy as a result of the NHS-wide cash squeeze and also because they insist that some patients’ condition clears up while they wait.

A Liberal Democrat MP, Norman Lamb, a former health minister, said the move was “a shameful indictment of the under-funding of the NHS” that would prove unfair and divisive. “It undermines the core principles of the NHS: that everyone should get compassionate treatment, as early as possible, when they need it. Those who can afford it will go private to skip the wait, while others will be left waiting in pain and discomfort. This is simply impossible to justify.”

Trafford CCG in greater Manchester has confirmed that it is also considering bringing in a similar policy, according to the Health Service Journal (HSJ), which first reported on the plans.

NHS England oversees all 209 CCGs which between them spend over £60bn of the NHS’s £125bn annual budget. It appeared to back minimum waits, despite the controversy they have aroused.

A spokesman for NHS England said that with health budgets so squeezed that NHS bodies face “difficult choices” about what they spend their money on. However, there are doubts about whether it is legal for any CCG to bring in minimum waits for care, given that patients are supposed to be guaranteed in the NHS constitution that they will be treated as soon as possible.

Lincolnshire West CCG told HSJ that it had “a responsibility to ensure public money is spent effectively and efficiently”. It added that “there is evidence that some conditions do get better over time and that, in some cases, surgery may be unnecessary” though did not specify to which conditions it was referring.

The commonest non-urgent operations hospitals perform include removal of cataracts, replacement of a worn-out hip or knee and the repair of a hernia.

The Royal College of Surgeons (RCS) said making patients wait at least 13 weeks for treatment was “arbitrary” and “ethically wrong” because patients would suffer.

Sue Hill, the college’s vice-president, said: “We strongly urge all these CCGs to reconsider this decision. Patients in Trafford currently wait an average of 7.2 weeks for any type of treatment. If this policy were to go ahead average waiting times in Trafford would double and it is difficult to see how these targets coud be achieved.”

While the RCS appreciates the severe financial pressures facing CCGs, “introducing an arbitrary minimum waiting time for surgery is unlikely to save money in the long-term and is ethically wrong. Delaying surgery can mean a patient’s condition worsens, and can make surgery more difficult and less successful,” added Hill.

Cambridgeshire and Peterborough CCG was the first to bring in minimum waits for non-urgent surgery, also for 12 weeks. But it recently abandoned the policy two months after it was brought in.

Minimum long waits for treatment were banned when the coalition was in office through a ruling in 2011 by the now defunct Cooperation and Competition Panel. However, it appears that that applied only to primary care trusts, which CCGs replaced, and not to CCGs, which hold the NHS budget across England.

Jon Ashworth, the shadow health secretary, urged the government to prevent NHS bodies from using the tactic. “I’m demanding Jeremy Hunt intervenes, enforces the NHS constitution and bans these minimum waiting times. Secondly, in the budget Theresa May must provide the NHS with the money it needs to end this postcode lottery of care that has developed under the Tories.”

An NHS England spokesperson said: “CCGs face difficult choices about what can be afforded within the funds parliament has made available, recognising the priority being accorded to emergency care, mental health, cancer and GP services. Last month 1.3 million patients started consultant-led elective treatment and the vast majority of patients wait less than 18 weeks.”

Anger after report finds birth defects not caused by hormone pregnancy tests

A hormone pregnancy test used in the 1960s and 1970s was not responsible for serious birth defects, according to an official review, which has been severely criticised by campaigners.

An expert working group set up by the Commission on Human Medicines (CHM) concluded there was no “causal association” between a drug called Primodos and severe disabilities in babies.

However, MPs and families who have campaigned against hormone pregnancy tests (HPTs) for more than 40 years, said the report was a whitewash.

Yasmin Qureshi, the MP for Bolton South East, said there should be a judicial review or a separate inquiry to examine allegations of a cover-up by medical regulators at the time.

The Labour MP said: “I am completely disgusted by the report. They clearly have not looked at the evidence that was presented to them. If they had looked at the evidence presented to them they could never have arrived at the conclusion they have now. This report is a complete whitewash. It is not worth the paper it has been printed on.”

Mims Davies, the Conservative MP for Eastleigh, said she was disappointed by the report and would be meeting with the prime minister to raise her concerns.

Davies said: “I was thoroughly dissatisfied by the complete lack of transparency in the creation and preparation of this report, with the only representative of campaigners against these historic injustices on the panel being gagged by a confidentiality agreement and prevented from speaking about the report’s preparation.”

The expert group recommended that families who took an HPT and experienced an “adverse pregnancy outcome” should be offered genetic testing to establish whether there was a different underlying cause.

Campaigners believe that as well as causing disabilities, the drugs could also cause miscarriage or stillbirth.

Marie Lyon, chair of the Association for Children Damaged by Hormone Pregnancy Tests, said: “It’s truly shocking and I am appalled by the report. We all feel betrayed, and I feel like I have no faith in government health agencies now. I am distraught for our members, who still haven’t had the answers they need.”

Charlotte Fensome, whose brother Steven has severe epilepsy, said she was horrified by the report.

“I’m obviously hugely disappointed by this report. My parents are 81 and 76, and they are struggling every day with my brother. Every victim of Primodos is a personal tragedy, and I am shocked at how this investigation has been carried out.

“My mother was given Primodos when she was eight weeks pregnant, and my brother was born with severe brain damage. It affects the whole family every single day. This is just a battle, and there is a long war ahead.”

The expert group assessed a number of studies looking at a possible link between women given an HPT to diagnose pregnancy and congenital anomalies in babies, but concluded there was no connection.

The expert group found that “although there was never any reliable evidence that HPTs were unsafe, concern about this issue, coupled with the development of better pregnancy tests” led to the use of HPTs being restricted in the 1970s.

A 1967 report found there might be a link between HPTs and spina bifida, and – following the thalidomide scandal which had recently led to that drug being withdrawn – concerns about HPTs rose dramatically.

Primodos, which was also used to treat menstruation problems, was then withdrawn completely in 1978. “Whether these precautionary actions were sufficiently timely became a subject of controversy,” noted the report.

Modern pregnancy tests measure hormone levels in a woman’s urine. The older HPTs contained synthetic versions of two hormones found naturally in the body. Two pills were taken on consecutive days, with a withdrawal bleed a few days later in those who were not pregnant.

Primodos contained synthetic versions of progesterone and estrogen.

Prof Stuart Ralston, the chair of the CHM, said: “This was a comprehensive and wide-ranging scientific review of all the available evidence on the possible association between HPTs and birth defects by internationally leading experts across a broad range of specialisms.”

Dr Ailsa Gebbie, the chair of the expert working group, said: “Our recommendations will strengthen further the systems in place for detecting, evaluating and communicating risk with use of medicines in pregnancy and help safeguard future generations.”

A spokeswoman for Bayer AG, which acquired Primodos manufacturer Schering in 2006, said: “Bayer notes that a review by an independent expert working group on hormone pregnancy tests of the Commission on Human Medicines has found, consistent with Bayer’s view, based on all available data, that the scientific evidence does not support a causal association between the use of hormone pregnancy tests, such as Primodos, and birth defects or miscarriage.”

Long NHS delays can be ‘devastating’ for patients with eating disorders

People with an eating disorder are waiting as long as five years to start treatment on the NHS, putting their recovery in peril, according to a report.

Beat, a charity which helps people suffering from anorexia and bulimia, warns that delays to access vital care can have a “devastating” impact on those with eating disorders.

It stresses that while the five-year wait was a one-off, too many patients are waiting too long to see a specialist, despite recent efforts by the NHS to provide more services and cut waiting times.

Patients wait on average six months after first visiting their GP about their condition before they start treatment, it said. Some have been made to wait as long as that – 26 weeks – just to have the appointment at which they are assessed, after being referred for help by their GP.

And it can then take as much as 13 weeks after the assessment appointment before they see a psychiatrist who specialises in treating eating disorders, Beat said.

Its findings are based on the experiences of 1,478 patients who responded to a survey the charity undertook.

“The impact of having to wait a long time before receiving treatment can be devastating for eating disorders sufferers and their families,” said Andrew Radford, Beat’s chief executive.

“Eating disorders are serious, complex mental illnesses and early intervention is key to recovery. All evidence tells us the sooner someone with an eating disorder gets the treatment they need, the more likely they are to make a full and sustained recovery,” he added.

Around 725,000 people in the UK are estimated to have an eating disorder, and the conditions cost the NHS about £4.6bn a year to treat. Almost 90% of sufferers are young girls or women.

It takes on average three and a half years between symptoms emerging and the sufferer starting treatment, with the gap among adults seeking help double that found in children. People typically take over 18 months to realise they have a problem and then more than a year before they seek help, Beat found.

Under NHS England waiting times targets for eating disorders, under-18s who are classed as an emeregncy should receive treatment within 24 hours, urgent cases should be seen inside a week and non-urgent cases within four weeks.

Barbara Keeley, Labour’s shadow cabinet minister for mental health, said that official waiting times performance figures showed that many young patients were still not receiving timely care.

Between July and September, 29% of urgent cases did not start treatment within a week and 17.6% of patients did not begin routine treatment within four weeks.

“This [Beat] report suggests that Tory ministers need to snap out of their complacent attitude to the treatment of eating disorders. It is yet more proof that warm words from the Tories haven’t been met with firm action to improve services in the community,” Keeley said.

Research by Labour found that a few NHS mental health trusts have reported worryingly long waits for children and young people with eating disorders.

Tees, Esk and Wear Trust reported eight urgent cases who had waited over four weeks, five of whom waited over 12 weeks, and 44 routine cases who had waited longer than 12 weeks.

Avon and Wiltshire Trust had five urgent cases waiting four to 12 weeks and 13 routine cases in which those involved had waited over 12 weeks.

Dr Marc Bush, YoungMinds chief policy adviser, said: “Sadly, these figures chime with what we hear on our helpline, from worried parents who are desperately trying to get support from child and adolescent mental health services.”

Bush added: “Parents of children with eating disorders say that their children have been turned away because their weight isn’t low enough, or that they’re put on long waiting lists, during which time the situation can get worse.

“While services are improving in some areas, these figures suggest that too often NHS targets for the treatment are not being met. It’s also clear that there is still a huge amount of work to do to help young people recognise when they may be developing an eating disorder and seek help earlier on.”

An NHS England spokesperson said: “There are now 70 NHS community eating disorder services for children and young people covering the whole of England, backed £150m of investment. As a result, eight in ten young people now get care within four weeks, and three-quarters receive urgent treatment in a week, so progress is clearly being made.”

‘We are a force to be reckoned with’: voices of newly qualified nurses

‘I finish most shifts feeling guilty and remember things I didn’t have time to do’

Nursing isn’t what I expected it to be, there’s never enough time for patient contact which really saddens me. Nurses are now mainly office-based and have to delegate the patient contact to healthcare workers. I often class a good shift as one where I have managed to sit down and talk to someone who needed me. I finish most shifts feeling guilty and wake up in the middle of the night and remember things I didn’t have time to do. The stress of the job is unbelievable.

The pay conditions really anger me. Working in mental health can be a risky job where staff are assaulted and have to face quite a lot of abuse. I do not think it is fair that I only get paid around £10 an hour, which is a lot less than my friends who do low-level administration work in offices where they get paid to answer the phone. The government is relying on the good nature of nurses to continue doing their job because they care.
Kate Clayton, 15 months post-qualified, mental health nurse, Staffordshire

‘Nurses are a force to be reckoned with – I think that has become more prominent in recent years’

Before I began nursing I didn’t really see nurses as specialists or professors. It was only during my nursing studies and hospital placements that I began to realise the breadth of opportunities within nursing and the new found confidence nurses have. Nowadays we all work as a multidisciplinary team (MDT) and nurses work more closely with doctors and allied healthcare professionals. We, as nurses, are encouraged to speak up, ask questions and play a bigger part in the MDT and in our patients’ care plans. We also now have so many different opportunities for nurses like specialist roles, research and education. I think in the future we will see a lot more nurses going on to do the likes of PhDs and more specialist training. We are a force to be reckoned with and I think that has definitely become more prominent in recent years.
Bebhinn O’Dowd, 12 months post-qualified, critical care research nurse (specialising in major trauma), London

‘We are constantly working more hours than we should because it’s so short-staffed’

There is so much responsibility in modern nursing. You literally have people’s lives in your hands. It’s a big burden for a 22-year-old. Some older nurses have told me that in the past we would have been slowly fed into the system instead of being thrown in and immediately pushed to the limits. We are constantly working more hours than we ever should because it’s so short-staffed.


It seems more of an uphill battle to get what is deserved and to get the kind of respect nurses used to get

Liv Webster

Pay is of course something my friends and I rant about and some people who I studied nursing with have already changed their career path – we’re not even 18 months qualified. A lot are being pushed into private sectors and agency work so the NHS is losing valuable members of the team who can’t deal with the pay when they have families to support. Having said that I absolutely love my job and wouldn’t do anything else.
Ella Clarke-Billings, 14 months post qualified, surgical nurse, London

‘I didn’t realise the monumental amount of paperwork that nursing incorporated’

I went straight into the private sector due to more opportunity. I would have preferred to work for the NHS at the time but in my specialism I found it very hard to get into. I wanted to be a liaison nurse, which is a role to support people with a learning disability while they are in hospital, but people don’t seem to leave those jobs once they’re in them as they are so good to have. There is definitely more room for climbing the ladder in the NHS but that’s not what interests me. For me, getting the right healthcare for my service users and supporting them to have the best quality life they can is what’s most important. It’s why I wanted to become a nurse – to be the voice for those that couldn’t be heard and that’s what I can do in the company I work for.

I didn’t realise the monumental amount of paperwork that nursing incorporated. I definitely thought it would be more hands-on than it is. It seems more of an uphill battle to get what is deserved and to get the kind of respect nurses used to get, especially in my specialty which other health professionals seem to deem as useless. People don’t view learning disability nurses as proper nurses as we deal a lot with the social side and not just the medical side of care. I have even had family members joke that I’m not a proper nurse; when you aren’t given that level of respect it can really deflate you.
Liv Webster, 15 months post-qualified, learning disabilities nurse, Lichfield

‘Coming into nursing is different but it’s important to see it as a vocation rather than a job’

Nursing has certainly changed since I started in the early 1970s. The introduction of technology has had a big impact. I’ve seen the introduction of electronic health records, email and e-learning, and this kind of innovation has helped improve the practice of learning for the benefit of patients and carers. Many nurses had to adapt to the change and for some it was a difficult time as they did not have the computer skills required. For new nurses this will never be a problem as the way they study is academic and they have been brought up with technology.

But ultimately a good new nurse will have the same core skills and qualities, such as empathy and compassion, as when I trained. Coming into nursing now is different but it is even more important now that those entering see it as a vocation rather than a job. It is a hard career albeit rewarding.
Helen Smith, 41 years post qualified, mental health matron and ward manager, West Midlands

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

Fewer consume sugary drinks but decline is uneven across US, study says

Fewer Americans are drinking sugary beverages each day compared with a decade ago, but the decline is not evenly spread among the population, a new study shows.

The Harvard TH Chan School of Public Health study found that over 10 years, some minority groups were as likely to be drinking one sugary beverage per day at the end of the study as they had been at the outset.

“Sugary beverages are the single largest source of calories for many people in the US and they are also highly linked to obesity,” said the study author Sara Bleich, professor of public health policy at Harvard. “So, we want to understand what the trends are, and do those trends vary among groups and among children?”

The sugary beverages, including soda, punch and sports drinks, have become a target for public health campaigns worldwide in the last decade.

The findings of the study, published in the journal Obesity, are significant because they are likely to guide public health experts’ future efforts to enact soda taxes.

The World Health Organization last year urged all countries to consider adopting these taxes to curb obesity, but campaigners face strong opposition from food and beverage companies.

Despite how hard it is to enact the taxes, those in place in cities including Philadelphia appear to be working based on preliminary data, Bleich said. Chain retailers in Philadelphia saw a 57% decline in the total sales of sugary beverages six months into the tax, Bleich said, compared with Baltimore, Maryland, which was used as a control city.

From 2004 to 2014, the proportion of children and of adults who drank sugar-sweetened beverages dropped, according to the study. In that period, the percentage of children drinking the beverages sank from nearly 80% to 60%, and the percentage of adults fell from 61% to 50%.

However, not all groups saw a decline. Researchers did not find any significant decline in the proportion of Mexican American, non-Mexican American Latinos and black Americans between 20 and 39 or older than 60 who drank the beverages.

“These groups are at higher risk for obesity, and tend to be low-income populations,” said Bleich.

Researchers used data from the National Health and Nutrition Examination Survey. In 2013-2014, that study sampled 14,332 people from 30 different locations. Workers from the US Centers for Disease Control and Prevention interviewed each of the participants. Of those selected, 10,175 completed the interview and 9,813 were examined.